This thesis presents the usability evaluation of the user-interface prototype of the PArents Decision Support (PADS) framework. The PADS framework is the first decision support system to address ethical decision-making in Neonatal Intensive Care Unit (NICU). But due to the historical resistance of information systems by clinical staffs, does this system have the potential of being accepted into the NICU? We took the user-centric evaluation approach by rapid prototyping and conducting a pilot study with clinical users to assess whether this prototype satisfies basic usability requirements. Our results indicated that all of the clinical evaluators found the prototype moderately easy or very easy to use, as well as being consistent with the concepts and terminologies used in their clinical practices. Based on those results, we conclude that the UI prototype satisfied the usability objects we set out and that the PADS framework's requirements has partially been validated.

The present study developed and validated a comorbidity index specifically for prediction of in-hospital mortality among diabetic inpatients in Canada. The analysis was based on data from the Hospital Person-Oriented Information Database (HPOI) for the study period from 1995/96 through 2000/01. The study included all the hospitalizations with a primary or secondary diagnosis of diabetes (ICD-9 code: 250.x) in acute care hospitals for patients aged 45 years or older with a length of stay of 90 days or less in ten provinces. All episodes of hospitalization for each patient were linked using a unique patient identifier, and one was randomly selected for the analyses. The study population of 578,222 diabetic inpatients was randomly divided into two parts, which were used either to develop or to validate the index. Multiple logistic regression models were used to develop and validate the index. A total of 22 diabetic comorbidities including 14 coexistent general medical conditions and 8 diabetic complications were included in the study-derived index, which had a better predictive performance as compared with D'Hoore-Charlson index and the simple count of comorbidities. The study-derived index can be used to control for potential confounding caused by comorbidity in the exploratory data analysis of diabetes research, to assist in creating more effective diabetes management system and to evaluate the prognosis of diabetic inpatients for health care provider.

There are many unanswered questions regarding the influence and effectiveness of accreditation programs on healthcare services. Many participants advocate the value of the process and site reform and success experienced as a result of sharing in a program. However, there are many health service providers who have not chosen to participate. This single case study has been initiated as an opportunity to investigate the impact of an accreditation program on a health region and examine the consequences and results of the process on that organization. This study specifically focuses on the impact the process has on teams within the health organization. This report will be used in a broader multi-case study comparison to view similarities and differences in the results of accreditation. The site of this specific case study was an Alberta Health Region. The accreditation process was undertaken in this region for the first time in the history of the organization under the regional model. (Abstract shortened by UMI.)

Life-expectancy and Life-years lost are frequently used and analyzed indices of survival. Life tables and Markov models are two exact approaches to calculate these indices; however cumbersome calculation limits their usage in real situations. Some simple approximation approaches have therefore been developed since a convenient and accurate approximation is critical both to develop a treatment plan of a patient by physicians and to assess health policies by health policy makers. These approximation approaches include the DEALE (Declining Exponential Approximation of Life Expectancy), new DEALEs, the IPH method (A method developed at Institute of Population Health, University of Ottawa) and the Keyfitz approach. A new approach has been developed to achieve better accuracy and maintain ease of application by extending the Keyfitz approach. To make the new approach less dependent on age-stratified tabulations, a convenient formula for the EME (Established market economics) region is developed. Its accuracy, robustness, and ease of application are demonstrated.

Clinical Decision Support Systems (CDSS), for providing patient specific advice, can only be accepted in clinical practice if they can fit in a clinician workflow. This would require such a CDSS to have diversified support capabilities, to be mobile, and to have flexible functionality. Such a system can be designed and developed only in a modular fashion where the high level abstractions describe the logic among different system components. Ontology, which is a formal specification of shared conceptualization, can be used to create a high level abstraction. Such decoupling of abstract CDSS logic from low level implementation facilitates developing and adding new applications and increases the reusability of different system components. In this research it is argued that a developed CDSS, according to ontology driven design with the ontological model of a problem domain expanded by a clinical decision support requirements, allows the creation of a system that is aligned with clinical workflow. In this research the proposed approach is illustrated with the CDSS for triaging pediatric hip pain (HP) in the Emergency Department. This application (called MET-HP) is created within the MET (Mobile Emergency Triage) environment that implements the ontology driven design principles. MET-HP is a mobile CDSS that includes a decision model derived from the analysis of retrospective chart data and it facilitates early triage of a child using incomplete data. Keywords. Ontology; ontological model; ontology driven design; ontological engineering; clinical decision support system; data mining; knowledge model; knowledge based system.

Surgical site infection surveillance (enumeration, and reporting of cases) reduces infection incidence. Data-driven "trigger" mechanisms focus surveillance on high-probability cases, yet often lack specificity. We aimed to develop trigger mechanisms with greater specificity for surveillance of cardiac surgical site infection. We developed these mechanisms in a two part study: systematic review to identify potential trigger factors; and nested case-control study to derive trigger mechanisms from a novel information structure called a data warehouse. Among 158 studies, we identified 570 trigger factors, which we grouped into themes, using the top 33 in the case-control study Using 203 cases and 516 controls, we derived two models for surveillance trigger mechanisms. These models provided true positive rates of 0.941 and 0.931 respectively (non-inferior to the current trigger mechanism), with false positive rates of 0.1085 each (superior to the current trigger mechanism). These trigger mechanisms may standardize and automate surgical site infection surveillance triggering.

The Ottawa Influenza Decision Aid (OIDA) is a newly developed tool to assist healthcare personnel (HCP) make an informed decision regarding the seasonal influenza vaccine. The primary objective of this thesis is to determine approaches to implementing the OIDA into healthcare organizations by 1) conducting a systematic review of influenza immunization campaigns for HCP; 2) facilitating consultation meetings with healthcare organizers to collect their ideas on using the OIDA within their workplace; and 3) develop an OIDA implementation questionnaire based on the findings from the systematic review and consultation meetings. The systematic review results suggest that education-only campaigns only have a minimal impact on immunization rates. Future studies require improved reporting on the follow-up of HCP and calculation of HCP immunization rates. The consultation meetings identified ten approaches to implementing the OIDA within a healthcare setting. The OIDA Implementation Questionnaire was designed and a survey implementation approach recommended.

Research Question: This research will assess whether the Roma population are able to effectively access primary care services, and if not, what barriers prevent them from doing so. Background: The Canadian International Development Agency (CIDA), in partnership with the Serbian government and the Canadian Society for international Health, has prioritized equitable access to healthcare services for vulnerable populations in Serbia. As part of this larger initiative, the factors that affect access to primary care services for the Roma population will be analyzed in an attempt to determine if and how services can be improved. Methodology: Disaggregated data was collected from three population groups in Serbia; the general population, the poorest quintile (not including the Roma), and the Roma population. The effective coverage framework, which incorporates availability, affordability, accessibility, acceptability, and effectiveness, was used to structure the analysis. Results: This research found that the Roma are disadvantaged across a range of equity dimensions. The Roma are less likely to be able to afford health services, or physically access primary care centers, and are more likely to be discriminated against by health workers.

The recognition of the need to improve communication has led healthcare organizations to integrating health informatics technologies. This study investigated the extent to which mHealth applications influenced communication and information sharing patterns between interdisciplinary healthcare providers in the delivery of healthcare services. The study was conducted at a multi-campus health organization in Ontario. Sociotechnology theory examines the influence of sociological factors in the introduction and use of information and communication technologies. Through a sociotechnical approach, this research study focused on how the communicative and social aspects of an organization influence health informatics integration, as well as the extent to which information sharing and communication patterns were influenced. This study found that several factors contributed to the integration of mHealth technologies, including: significant end user contribution to system design, an organizational culture open to technological change, the use of creative internal communication practices, training, and evaluation procedures. Findings indicated that the limited use of mHealth technologies were a result of poor ergonomical design and a lack of employee consultation prior to integration. That being said, participants indicated that the accessibility of information and convenience of mHealth technologies ameliorated their work routines. Research shows that health informatics has the potential to improve healthcare service delivery, and consequently, future studies must look at the affect of these technologies on the fundamental elements of healthcare, including communication and information sharing patterns among healthcare providers.

In the immediate aftermath of Chaoulli vs. Quebec (Attorney General), it seemed that this decision would constitute a turning point in the way public health care is delivered in Canada. However, the lack of change in the following years has left this theory largely suspect. This thesis sets out to establish how two separate, yet equally powerful reactions to this case, proliferated in the wake of this decision. It aims to validate an original hypothesis that suggests that the treatment of the case from academia and from the print media (Canadian daily newspapers) constituted the most dominant discourses in the wake of the Chaoulli case. Furthermore it examines whether these two sectors were predominantly homogenous in their views of the case. However, this thesis concludes that, while these were two of the most dominant reactions to the Chaoulli case, the boundaries of these discourses and their respective supporters were not relegated exclusively to any given sector.